Audio: “Hello. I’m Andrew Schorr from MD Anderson Cancer Center. We’re talking about thyroid cancer, which affects about 48 thousand Americans each year—more often, women. A specialist in that is Surgical Oncologist, Christine Landry. She’s at the Banner MD Anderson Cancer Center in Gilbert, Arizona. Dr. Landry, thank you so much for being with us.

Image: Dr. Landry on camera

Audio: “Well, thank you for having me.”

Image: Andrew Schorr on camera

Audio: “Dr Landry, so thyroid cancer—first of all, a lot of people aren’t really clear on where is the thyroid gland. Where is it?”

Dr. Landry Audio: “The thyroid gland is on the neck, right here, and it overlies the trachea, you’re breathing tube.

Andrew Schorr Audio: “And how big is it?”

Dr. Landry Audio: “It’s about eight centimeters in size, lengthwise and distance, about three centimeters in size.”

Andrew Schorr Audio: So, when you have a physical and your doctor checks right where we think the Adams apple is, is that where the thyroid is? “

Dr. Landry Audio: “Just below that area, yes.”

Andrew Schorr Audio: “I see. Okay. So thyroid cancer—how would somebody even know maybe they had it? What would be a reason that somebody might come in and get checked for it?

Dr. Landry Audio: “Well, often their primary care physician or the patient themselves, they feel a nodule in their neck. So they see their primary care physician, who would then order an ultrasound to take a better look at the thyroid gland to see if there are any nodules. Other symptoms they could have would be hoarseness, difficulty swallowing. Sometimes they have difficulty breathing. But, most of the time, most patients do not have any major symptoms.”

Andrew Schorr Audio: “Would you feel a lump in your neck?”

Dr. Landry Audio: “You could. Sometimes they may. Usually feeling it with your fingers or, sometimes, a hard time swallowing.”

Andrew Schorr Audio: “Well, feeling anything like that or being told it’s a cancer is scary. Tell us about the most common type of thyroid cancer and what the treatment is.”

Dr. Landry Audio: “The most common type of thyroid cancer is papillary thyroid carcinoma, and that comprises approximately 80-percent of all thyroid cancers. And the primary treatment is to remove the thyroid gland and, after that, patients will require thyroid hormone therapy and sometimes patients require radioactive iodine.”

Andrew Schorr Audio: “Now, this gland is pretty accessible to you as a surgeon. All surgery is significant but it’s not like having heart surgery.”

Dr. Landry Audio: “No. It’s not like having heart surgery. The major risks of surgery would include low calcium from injury to the parathyroid glands or hoarseness from injury to the recurrent laryngeal nerves in the neck, which lie right next to the thyroid gland. Those are the most common complications.”

Andrew Schorr Audio: “So is this a long surgery if you have this procedure?”

Dr. Landry Audio: “It depends on the extent of cancer, if there is cancer involved. It could range anywhere from an hour-and-a-half to three hours.”

Andrew Schorr Audio: “You mentioned about follow up, potentially adding radioactive iodine, and then you take medicine as well. So what happens after the surgery for most people?”

Dr. Landry Audio: “After the surgery, we wait for the final pathology to come back and the specimen. We look at the size of the tumor, if lymph nodes are involved. All patients will require thyroid hormone suppression therapy if they have papillary thyroid cancer or a follicular thyroid cancer. But because we take the thyroid gland, everybody needs thyroid hormone to function. So for patients who have more advance disease, we do also consider radio active iodine therapy.”

Andrew Schorr Audio: “But typically people would take some thyroid pill for the rest of their lives.”

Dr. Landry Audio: “Right. They take one pill every morning, long term.

Andrew Schorr Audio: “I mentioned at the outset that it’s more common in women. Do we have any idea why?”

Dr. Landry Audio: “You know, we’re really not sure why women more commonly develop thyroid cancer. We do know one risk factor is exposure to radiation to the head and neck or if someone was exposed to an atomic bomb. Other risk factors include hereditary conditions but that’s more associated with medullary thyroid cancer.”

Andrew Schorr Audio: “What about age? I read that women of child-bearing age, it may show up then?”

Dr. Landry Audio: “It can happen at any age with younger women as well as older women and gentlemen. The prognosis is better if patients are diagnosed younger.”

Andrew Schorr Audio: “What about family history? So, if your mom had thyroid cancer, would that put you at higher risk?”

Dr. Landry Audio: “I would say you are at higher risk if your mom had medullary thyroid cancer because that’s associated with certain hereditary or genetic syndromes, such as multiple endocrine neoplasia type 2.”

Andrew Schorr Audio: “What about if somebody has thyroid cancer—is there any connection with other cancers, either ones they personally previously had? Or, if they’ve had the surgery and all of the treatment, should they worry about others just because they had the thyroid cancer earlier in life?”

Dr. Landry Audio: “It depends on the type of thyroid cancer diagnosed. Papillary thyroid cancer has been associated with certain genetic conditions that may predispose patients to developing colon cancer. If patients have medullary thyroid cancer, they certainly may be at risk for developing other endocrine tumors that are associated with multiple endocrine neoplasia type 2, for example.

Dr. Landry Audio: “Generally, we follow them every six months with an ultrasound and some labs, to include thyroid globulin and thyroid globulin antibody. And, over time, we decrease that frequency to every year and even every two years after a significant period of time.”

Andrew Schorr Audio: “For people who have been treated for the typical, most common thyroid cancers, then I get the impression they can go on with a full life.”

Dr. Landry Audio: “Generally, the prognosis for thyroid cancer is quite good, even if patients have evidence of thyroid cancer in the lymph nodes in the neck, the prognosis is very good.”

Andrew Schorr Audio: “Well, that’s all good news. And as far as somebody doing something to prevent it, obviously avoid radiation exposure, but otherwise, it’s just something that you can’t prevent. But if it’s detected, let’s say, in a routine physical and they’re feeling a nodule in your neck or you have that hoarseness that you mentioned or difficulty swallowing, then you proceed and see maybe even a subspecialist, such as yourself.”

Dr. Landry Audio: “Yes. A subspecialist is important. It’s important to go to a surgeon that does high volume thyroid surgery. There have been some studies that show patients have a better outcome.”

Andrew Schorr Audio: “Okay. Well, we’re glad we have a subspecialist at Banner MD Anderson and that you’ve give us your expertise today. Dr. Christine Landry, thank you so much for being with us.”

Dr. Landry Audio: “Thank you for having me.”

Image: Andrew Schorr addresses camera

Audio: Closing music over conclusion and titles.

Andrew Schorr Audio: “Andrew Schorr for Patient Power and Banner MD Anderson Cancer Center. Remember, knowledge can be the best medicine of all.’”